onsdag 20. januar 2016

Some of you may know it already; but it was new to me when I stumbled across it this morning--a 1989 BBC documentary about Wittgenstein's life, featuring, albeit briefly, Norman Malcolm. Not very exciting in terms of philosophical content, it does offer nice pictures from Wittgenstein's various homes.

torsdag 7. januar 2016

In the 1970s and 80s, Benjamin Libet, an American brain scientist, conducted a series of famous experiments. Instructed to carry out small, simple motor activities, such as pressing a button or flexing a finger, participants were placed in front of a clock with electrodes affixed to their scalps. During the experiment, the participants were asked to note the position of the arm of a clock when he or she was first aware of the urge to act. The experiments revealed an increase of electrical brain activity preceding the conscious decision to move by several hundred milliseconds. This subliminal brain activity was dubbed«readiness potential». While Libet himself has wavered somewhat in his interpretations of these findings, others unhesitatingly think this discovery has huge ramifications for our self-understanding. If volitional acts are initiated before we become aware of them, then we must be deluded when thinking our conscious«decisions»have any causal effect on what we do!

It may seem impossible to conclude otherwise. If electrical goings-on in our brans make our decisions, then in a sense we don't. But here one must not forget what a conclusion is in this context. The conclusion that we are not free is not a scientific discovery, but rather an interpretation of (or implications drawn from) certain scientific discoveries. Interpretation is a way of framing data, involving, at least tacitly, arguments based on some underlying assumptions. That human beings are mere neurological robots, therefore, is not an empirical fact, but rather the implications drawn from one possible interpretation of these facts. Am I then suggesting that this interpretation must be wrong? No. I only suggest that it is not obviously correct either. In other words, I am asking us to consider the possibility of reading Libet's data differently. How to read scientific discoveries, of course, cannot itself be a scientific question--at least not merely. This calls for philosophising.

Let us start by investigating why this gloomy conclusion may at first seem unavoidable.

Instinctively one might be alarmed to learn of the readiness potential. How unsettling that our brains decide for us! But as Wittgenstein once remarked, we often are struck by the wrong aspects of things: the important features escape our attention because of their familiarity (PI §129). Perhaps, then, the conclusion that subliminal brain activity diminishes the role of consciousness in human action seems so compelling only because we overlook something which is always before our eyes?

For example: There must be electrical goings-on in the brain all the time. Acknowledging this obvious fact should make some of the initial surprise ebb away. Electrical brain activity prior to conscious decisions is exactly what one should expect to find! After all, no brain activity is synonymous with brain death. Ok. But Libet did not merely record electrical humming in the brain—that, clearly, would be unstartling. What his experiments revealed was a significant increase of electrons firing some milliseconds prior to a conscious urge to act. Surely this warrants paying special attention to it, or am I denying that something imortant happens here? Well, not exactly. But if we take a closer look at one of Libet's graphs, will we not see the line going up and down all the time? And if that is the case, why single out this particular peak as particularly significant—rather than, say, regarding it as just another elevated stage in a normal pattern of fluctuations? Doesn't this peak seem rather randomly chosen? (Subsequent experiments have, in line with this logic, identified readiness potentials several seconds prior to any conscious urge to act.)

My intention with that rhetorical question is not to deny that a case can be made for «the compelling» conclusion, merely to emphasize that the case must indeed be made. One cannot simply take Libet’s assumptions for granted. Once his reading of the graph is seen for what it is, namely a reading, and the assumptions built into that reading are made explicit, then, my point is, we are positioned to see that other readings must be possible too.

But let us, for argument’s sake, grant Libet his reading of the graph's ultimate peak. Let us assume, then, that «readiness potential» was an established fact. Would this render conscious decisions causally ineffective in volitional human action?Before stampeding towards that conclusion, one thing we should notice is how anemic are the concepts of action and decision with which Libet operates. A severely limited understanding of these human capacities is buit into his research design, making it unclear how much of human action actually is illuminated by Libet's research. Purposeless finger flexing and random button pushing are (at best) special instances of human action--if indeed «bodily movements» is not a better term for them than «human action». However we categorize it, the behaviour of Libet's subjects is quite unlike much of what we otherwise think of as human action. Furthermore, Libet’s experiments were purposely designed so as to make the timing of the movement irrelevant. The participants were to have no reason for preferring sooner over later. Some human actions may very well be like that—at least they were in Libet's artificial settings—but more often than not do we care about what to do and when to do it. To make a long story short: It will take a considerable amount of philosophical work on Libet’s part to make this convincing as a paradigmatic picture of human behaviour. (Which is needed for the implicit general rejection of conscious decisions to be plausible.)

And what does it mean to say that an action is «initiated»? Being clear on that point is of course crucial when reflecting on the implications of Libet's findings. The readiness potential is conceived as a brain activity initiating human action at a particular moment in time. But does it make sense (and if so, what sens does it make) to think of all volitional actions as subliminally initiated some milliseconds before they occur?

Sometimes we say that it took us time to make up our minds on what to do, suggesting a picture of a long inrun before a sudden take-off. A typical case would be the child who hesitates for a long time before suddenly ripping off a band-aid. Now, it seems plausible that certain happenings in the motor center of the brain—i.e. a «readiness potential»—can explain the sudden motion. But could it not also be argued that these electrical goings-on only mark the final stage of the initiation process? That the initiation of the initiation, as it were, began when the child first formed the intention to rip the band-aid off? Consider also planned actions. How much light does the readiness potential shed in such cases? Take, for example, someone who finally asks for his girlfriend’s hand in marriage. A lot of preparation has led up to this moment: For months he has deliberated on how best to approach it; he has considered different options for time and place—should he propose at midsummer and out at sea, or rather wait until her birthday when her favorite flowers blossom?; he has rehearsed the question (the exact formulation of which he has actually written down on a piece of paper in his pocket); he has booked a hotel suite; bought a ring, and today he has picked up a lovely bouquet of roses. If someone were to explain the time and manner in which he proposed in terms of electrical signals firing in his brain, then there are reasons—not empirical reasons perhaps, but certainly philosophical ones—for being sceptical about their approach. Of course this man would never have performed as he did but for electrical firings in his brain—but, this surely is a very thin explanation, and miles away from what we under all but very limited circumstances would consider an answer to the question of what prompted him to propose when and how he did.

When a woman last year confessed that she would not know what to do if her fetus were diagnosed with Down’s syndrome, Richard Dawkins promptly replied: "Abort it and try again. It would be immoral to bring it into the world if you have the choice." Reactions came from all corners of cyberspace, and Dawkins was later forced to explain himself. Tweeting his opinion had probably been unwise; a medium that allows a little more space for reasoning would have been a better choice. His mea culpa went no further than that. He admitted that he should have expressed himself differently; but as for the opinion expressed, he saw no faults with that: "Apparently I'm a horrid monster for recommending what actually happens to the great majority of Down Syndrome foetuses. They are aborted." I believe, however, that this distinction between the form and the content of his message is less clear-cut than Dawkins believes. People reacted against the tone of his "recommendation" because of the attitude it expressed (toward the "content").

Dawkins is right; the majority of these pregnancies are in fact terminated. In Norway this happens in 80-90% of the cases. But that was not his point, nor was he merely expressing agreement with the majority; Dawkins claimed that there could be no serious doubt about what is the right thing to do in such a situation. In this respect Dawkins agrees with the most militant anti-abortionist. This black-and-white picture is unhelpful in a number of ways. First, as with anti-abortionist slogans, his "recommendation" is likely to appeal only to those already share his view. Blind certainty, whether it be political slogans from the militant right or moralizing tweets from a grey-haired male professor, is hardly the sort advice a pregnant woman in a moral dilemma needs. In fact, there is a danger that she will experience this as undue pressure from on-high (an allegation Dawkins tried, though not convincingly, to wriggle away from since he had portrayed her “dilemma” as being a choice between morality and immorality). Finally, we may fear what discussions, such as the one initiated by Richard Dawkins, might do to our moral sensitivity. If Down’s syndrome becomes a topic of public debate, what does this say about—and what might it do to—our view of human beings with this syndrome? Might we be heading for a society where deselecting such fetuses increasingly will appear unproblematic?

It is particularly these latter questions I will discuss here. The discussion flared up in Norway when Aksel Braanen Sterri, a young social scientist, published an essay in a prominent weekly outlet with the deliberately provoking title "A Vindication of the Sorting Society". His argument relied partly on the observation "…that all parents want their children to be born as healthy as possible and to have all the opportunities other children have." At least good parents do. If prospective parents expressed wishes of children with Down’s or other syndromes, we would question their motives. But it is problematic to model our thinking in this context too closely on the healthy/sick distinction. "What would be so terrible with a society without Down’s syndrome," Braanen Sterri asked, addressing everyone worried about a possible sorting society. "Every medical progress means the danger of eradicating a disease that some identify with." But who sheds tears over the eradication of polio and tuberculosis today? Why assume it will be different with Down’s syndrome?

Well, because Down’s syndrome is different, according to Marte Wexelsen Goksøyr. "You cannot get rid of this condition without killing the person. That's the difference. I am myself a woman with Down’s syndrome. I am not sick; I have an extra chromosome in my cells." You don’t recover from having Down’s syndrome; there are no cures for it. This fact alone, of course, does not distinguish Down’s syndrome from a disease—there are, after all, many diseases still without a cure—but it does make a difference that we cannot because of this fact describe Wexelsen Goksøyr as having an incurable condition. To say that she is "incurably affected" by Down’s syndrome sounds just as awkward as to say that she as a woman is "incurably affected" by femininity—a choice of words suitable only if one’s aim is to make a joke on her expense. Refusing to view Down’s syndrome as a disease, Wexelsen Goksøyr prefers to describe her kind as a special type of human beings. Put differently: Braanen Sterri’s question shall not be answered, but rather reformulated. The question is not what would be so terrible with a society without Down’s syndrome, but rather what would be so terrible with a society without people with Down’s syndrome.

To be honest, I would prefer to stop here. I don't fancy addressing this topic. This confession probably will offend some. There are those who believe an intellectual should be ready to discuss anything. True, open-mindedness is an intellectual virtue; but it must not be so open that one's brain might fall out. A moral community is partly defined by what is not discussed. In Norway, for example, we no longer deliberate on the pros and cons of forced sterilization of Gypsies. But such values are not set in stone. Ali Esbati, a well-known journalist and politician, recently announced that he "is fleeing" to Sweden because of the tone in the political debate in Norway. A significant difference between the two countries, he writes, "is the way in which immigrants are described in the media and in the public debate." Since 2008, it has become commonplace to talk about the immigration problem in Norway, and as Esbati explains: "Constantly seeing oneself described in problem-terms does make a difference." Discussing the pros and cons of having people with Down’s syndrome among us will possibly have a similarly corrupting effect on our culture. And the pro-arguments are no better in this respect than the cons--both contribute to establish this as a legitimate question. That is why I would prefer giving the issue the silent treatment; but I am afraid it is too late for that. Turning my back on it for fear of disgracing myself and degrading those concerned would hardly accomplish anything at all. The topic has already contaminated our public debate--or in less moralizing terms: The chances that an appeal to decency will succeed in silencing the debate are slim since our sense of decency is already adapting to this debate. The questions are out there, discussed in all seriousness by decent people in the columns of distinguished newspapers.

I have sympathies with Wexelsen Goksøyr’s stragegy of rephrasing the question; refusing to discuss it in medical terms, but rather insisting on this being a question about people. Asking what would be so terrible with a society without a certain type of human beings (as opposed to a society liberated from a certain syndrome), does at least strip the possible future we are asked to consider of some of its immediate appeal. But how are we to proceed from this reformed question? Very often the debate gets side-tracked on the issue quality of life. Both Braanen Sterri and Dawkins claim that “healthy” people in general live better lives than most people with Down’s syndrome do, and welcome full-scale fetus selection because it allegedly will improve society’s overall life quality if all fetuses with Down’s were replaced by “healthy” ones. The opposition denies that removing people with Down’s will have that effect. People with Down’s syndrome, according to Wexelsen Goksøyr, often lead happy and fulfilling lives. Why is this a side-track? Because, behind this disagreement lies the uniting assumption that happiness is the central issue here. But if we assumed that people with Down’s on average were less happy than others, would this settle the matter? Of course not. The true problem here is not finding the most efficient way to aggregate happiness—whatever, if anything, that means—but finding ways to express our vision of human dignity and to understand which society serves that vision best. I sympathize with those who answer the reformed question by appealing to human diversity. If certain types of people—children with Down’s syndrome, left-handed people or people who love skiing—no longer were among us, we would live in a less diverse society. "It takes their kind to make all kinds," as the saying goes. A good society, on this vision, is a society which lets a thousand flowers bloom.

Wexelsen Goksøyr does appeal to the core values of the tolerant and inclusive society in her protests, and she does so with an existential force which commands us to listen. "I belong to a minority group in Norway," she writes, and one must be quite tone-deaf not to notice her existential horror at the prospect of "it [becoming] a state project to eradicate [this group], to sort them out." Currently Norwegian legislators are contemplating to introduce ultrasound screenings during the 12th week of pregnancy as a standard, so describing reality this way is not entirely unfair. (But here it is easy to err. Wexelsen Goksøyr lets herself be carried away by her own horror when she draws parallels between this screening program and previous cases of ethnic cleansing. "To wipe out these troublesome people [the Gypsies], to sort them out, children were taken from their parents and put in orphanages. Women were forcibly sterilized, some put in asylums and some lobotomized." If this were the methods by which Braanen Sterri's Down’s-free society were to be accomplished, then his apologia would hardly even provoke (let alone be printed in a reputable weekly). Such practices will not be reintroduced into Norwegian policy anytime soon. And yet, people with Down’s syndrome understandably feel personally threatened by these proposals.)

Obviously, as Richard Dawkins stressed, there is a difference between suggesting that a fetus ought to be aborted and saying of a child that it ought never to have been born. The latter would be downright vile. Dawkins' point was this. Systematically deselecting new people with Down's syndrome shouldn't concern those already among us. We should be allowed to discuss this possibility without offending anyone. My concern, though, is that this distinction might not be as sharp as Dawkins imagines. Is it possible for someone to contemplate a screening program where the consequence (if not objective) is that these children are no longer born without showing a degrading attitude towards such children? Maybe; but I don't see how. It is not simply a matter of chosing words. Limiting each tweet to 140 characters, Twitter is designed for snappy messages. Other media allow more caveats and careful reasoning. This may soften your message; but the unpleasant implications of your message are not so easily escaped. This is what Dawkins and Braanen Sterri don't sufficiently appreciate; that they are caught by the dynamics of the discourse in which they engage. While championing systematic deselection of "unhealthy" fetuses, they deny sending any message to the "unhealthy" individuals among us today. Through fancy distinctions, Dawkins attempts to wriggle away from Wexelsen Goksøyr’s accusation. But this--I imagine she would reply--only results in, well, wriggling: "Oh, my dear no. Of course I don’t mean to suggest that you are unwanted. What I say is merely that when discussing these matters, we must remain open to the possibility that the best solution, when all is said and done, may be that people like you are phased out.”

torsdag 12. mars 2015

Recently I moved to Trondheim. (It was with a heavy heart I left Svalbard, a decision made even more difficult by the fact that my family didn't. But when they join me in June I assume we will all settle in fine.) Since new year I have been part of a research group called RESET (Research Group on the Ethos of Technology). To be more specific, my work is concerned with the moral and scientific ambiguities within what is called Personalised Medicine. Hopefully, in three years time, I can on the basis of this work call myself Doctor of Philosophy. Being entirely new to this field (not philosophy but philosophy of medicine), familiarising myself with it has been quite time consuming. This is the main reason for my being so inactive on Blogger the past few months.

"Personal" is a buzzword in today's society. Amazon as well as Youtube offers personalised recommondations. The more personalised a service is, the better -- or so the cultural trend seems to imply. What then is more natural than hoping for a more personalised healthcare? This is what I hope to investigate. One challenge is separating hope from hype. Consider some key slogans: Away with the one-size-fits-all approach to medicine! The right treatment to the right person at the right time! Barack Obama touched both in a recent speech. What but Amen can one say to this? Disagreement seems impossible. But that is my problem too. If no alternative position is available (who, after all, thinks impersonal ill-treatment is the future?), I struggle to see what one hopes to achieve with this rhetoric. Nor is it obvious to me what is novel about it either. I mean, the rhetoric itself is clearly a recent invention; but what else is new? Obama seems to imply that medicine is about to be radically changed. But hasn't clinical medicine always been about treating individuals? The fact that no two people are identical and may react differently to the same drug has been known ever since Hippocrates. True, part of the vision is that genome sequencing will play a prominent role in future healthcare -- and this has become technologically possible only in recent years. Still, it is not clear to me why this should be thought of as representing a paradigm shift in medicine rather than as a refinement of existing scientific practices (nor for that matter, why it is best thought of as "personalising" medicine).